Thoracic aortic disease

Question 1

what is the right coronary cusp?

Answer 1

the cusp of the aortic valve immediately distal to the right aortic sinus

Question 2

what is the left coronary cusp?

Answer 2

the cusp of the aortic valve immediately distal to the left aortic sinus

Question 3

when do women become at greater risk of atherosclerosis?

Answer 3

post-menopause

Question 4

describe the progression of atherosclerosis?

Answer 4

foam cells
fatty streak
intermediate lesion
atheroma
fibrous plaque
complicated lesion / rupture

Question 5

give 3 conditions caused by atherosclerosis?

Answer 5

stroke
MI
aneurysm

Question 6

what is an aneurysm?

Answer 6

a localised enlargement of an artery caused by weakening of the vessel wall

Question 7

what is a saccular aneurysm?

Answer 7

aneurysm causing dilatation on one side of the vessel

Question 8

what a fusiform aneurysm?

Answer 8

aneurysm cauing dilatation on both sides of the vessel

Question 9

what is a false aneurysm?

Answer 9

aneurysm that involves the collecition of blood between the tunica intima and media of the blood vessel

Question 10

what can cause aneurysms?

Answer 10

hypertension
atherosclerosis
smoking
collagen abnormalities (Marfan's cystic medial necrosis)
trauma
infection (mycotic/ syphilis?

Question 11

what can cause false aneurysms ?

Answer 11

inflammation (endocarditis)
trauma
iatrogenic

Question 12

what are the signs of false aneurysm?

Answer 12

thrill
bruit
pulsatile mass

Question 13

what can false aneurysms lead to?

Answer 13

ischaemia

rupture

Question 14

what are the symptoms of thoracic aneurysms?

Answer 14

asymptomatic

• SOB
• dysohagia and hoarseness (ascending aorts or chronic)
• sharp chest pain radiating to back, possible dissection.
• pulsatile mass
• hypotension

Question 15

what is a type A aortic dissection?

Answer 15

any aortic dissection that affects the ascending aorta

Question 16

what is a type B aortic dissection?

Answer 16

any aortic dissection that doesn’t affect the ascending aorta

Question 17

what are the factors that can cause aortic disection?

Answer 17

hypertension
atherosclerosis
trauma
Marfan’s syndrome

Question 18

what can dilatation of the aorta lead to (in the aortic valve)?

Answer 18

aortic regurgitation

Question 19

what are the sypmtoms of aortic dissection?

Answer 19

• tearing, severe chest pain radiating to the back

- collapse (from tamponade, acute AR, esternal rupture)

Question 20

what are signs of aortic regurgitation on examoination?

Answer 20

• reduced or absent peripheral pulses
• hypotension/hypertension
• soft early diastolic murmur (AR)
• pulmonary oedema

Question 21

what are the investigations carried out for aortic dissection?

Answer 21

CXR (widenend mediastinum)
echocardiogram (false lumens of aneurysms)
CT scaning (false aneurysms)

Question 22

what is the treatment for type A aortic dissection?

Answer 22

surgery

Question 23

what is the treatment for tye B aortic dissecion?

Answer 23

meticulous blood pressure control

with Beta Blocker and rarelt sodium nitroprusside

Question 24

what can takayasu’s arteritis cause?

Answer 24

stenosis, thrombosis, aneurysms or aorta and main branches, renal artery stenosis, and neurological symptoms

Question 25

what is the treatment for Takayasu’s arteritis?

Answer 25

steroids

surgery

Question 26

what can cardiac syphilis cause?

Answer 26

syphilitic aortitis- aneurysm

aortic regurgitation

Question 27

what congenital conditions can cause aortic aneurysms?

Answer 27

bicuspid aortic valve
Marfan’s syndroma
coarctation of the aorta

Question 28

what is associated with a bicuspid aortic valve?

Answer 28

• aortic stenosis
• aortic regurgitation
• coarctation of aorta
• reduced tensile strength of aorta so prome to aneurysm and dissection

Question 29

what are the 3 types of coarctation of the aorta?

Answer 29

pre-ductal
ductal
post-ductal

Question 30

what are the signs of coarctation of the aorta?

Answer 30

cold legs
poor leg circulation

before left subclavan artery:
radial-radial delay
right radial-femoral delay

after left subclavian artery:
no radial-radial delay
right and left radio-femoral delay
rib notches

Question 31

what are the symptoms of coarctation of the aorta?

Answer 31

infancy (severe)
-heart failure
-failure to thrive
later life
-hypertension

Question 32

what imagig is carried out for coarctation of the aorta?

Answer 32

CXR (for rib notching)

CMRI (can visualise coarctation)

Question 33

what are the CVS conditions associated with Marfan’s?

Answer 33

vascular aneurysm
vascular dissection
aortic/ mitral valve prolapse causing reguritation